Provider Demographics
NPI:1255384236
Name:ANGEVINE, PETER DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:DOUGLAS
Last Name:ANGEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 W 168TH ST
Mailing Address - Street 2:ROOM 510
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3726
Mailing Address - Country:US
Mailing Address - Phone:212-305-1550
Mailing Address - Fax:
Practice Address - Street 1:710 W 168TH ST
Practice Address - Street 2:ROOM 510
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3726
Practice Address - Country:US
Practice Address - Phone:212-305-1550
Practice Address - Fax:212-342-6850
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214404207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery